title: Are women deciding against home births in low and middle income countries?
abstract: BACKGROUND
  Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings.
  
  
  RESULTS
  The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility.
  
  
  CONCLUSIONS
  There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.
authors.affiliation: Centre for Global Health, Population, Poverty and Policy and Division of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom. faj100@soton.ac.uk
authors.forename: Fiifi
authors.initials: F
authors.lastname: Amoako Johnson
authors.forename: Sabu S
authors.initials: SS
authors.lastname: Padmadas
authors.forename: Zoë
authors.initials: Z
authors.lastname: Matthews
mesh_terms: D017954:Africa South of the Sahara; D000352:Africa, Northern; D001208:Asia; D017691:Caribbean Region; D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007843:Latin America; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010298:Parity; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors